In laparascopic surgery a known device called Deep Suture is a needle holder made by REMA.RTM. Medizintechnik GmbH of Germany, D-7201 Durbheim-Tuttlingen, In Breiten 10 Germany. It is believed that a German patent corresponding to this device is DE 42 10 724 C1, a copy of which in German is attached hereto as Appendix A and incorporated herein by reference.
While this device has various inherently good features, a number of significant improvements have been developed as disclosed in this application. The prior device, in summary, has a central shaft with proximal and distal ends. Extending through the shaft is a rotatable rod having a control handle at the proximal end and a drive gear at the distal end. A pair of driven gears are positioned at the periphery of the drive gear at opposite sides thereof, each driven gear coupled to an arm or wing that pivots radially outward from the shaft when the control handle is turned. Each wing includes a recess or blind hole for receiving the proximal end of a suture needle. In operation a single strand of suture material has its ends threaded through the eye of each of the needles, the suture then extending as a double strand from each needle. The proximal ends of the needles are then inserted in the wings, and the wings are pivoted to their retracted position whereby they and the needles are radially inward of the outer cylindrical boundary established by the central shaft. To facilitate this an axial groove is provided in the shaft into which each needle can move. The device, with wings retracted, is inserted down into the opening in the abdominal wall produced by a trocar. During insertion the suture is dragged down.
When adequately inserted downward the wings are pivoted to open position exposing the needles now pointing upward. The shaft is withdrawn until the needles pierce the wall and protrude out of the wall. These needles are engaged individually by a clamp, forceps or a needle holder or by a clamping device movable axially on the shaft and drawn through the tissue, pulling the suture until it forms a loop beneath the opening. The wings, now empty of needles, are pivoted closed, and the shaft is extracted from the opening. The needles are cut off the suture ends and the suture is tied.
The improvements in this device are described below.